MCH Clinical Workflow

Scope Boundary

This page covers the MCH Unit-specific workflow — KKIA registration, antenatal booking/follow-up allocation, MCH consultation & conditional pathways, and the MCH ED/Labor Room referral protocol. Shared front-door mechanics (general triage, registration, QMS allocation, pharmacy discharge, and appointment rules) are defined in the OPD Patient Journey↴ and OPD Referral & Escalation↴ pages.

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1. Patient Flow Summary

Steps 1–2 (triage and initial registration) follow the OPD General Patient Journey↴. The MCH-specific pathway begins at the KKIA Registration Counter.

1

1. Triage & KKIA Registration

Booked

• Patient arrives at Triage Counter A
• If maternal, postnatal, or child-related → redirect to KKIA Registration Counter (Counters 10–11)
• Basic profile registration, payment if applicable, checklist issued
• No appointment: Antenatal acute → discuss with KKIA MO or refer to OPD. Antenatal booking → appointment given. Other cases → discuss with KKIA MOs.
• Has appointment: Antenatal follow-up → allocate to lab for Hb & urine test before room assignment

2

2. Allocation to MCH Room

Waiting

• Staff assigns patient to nurse (Room 20/22/23) or doctor (Room 24/25)

3

3. Vital Signs & Screening

• Nurses record vitals using the Maternal Health Assessment Template
• Patient directed to assigned nurse or doctor room

4

4. Consultation & Documentation

In Progress

• Use appropriate MCH template — see Documentation Standards↴
• Ensure accurate SNOMED-CT coding
• Consultation, assessment & treatment given
• Further conditional pathways according to scenarios:

A

Escalation to MO

• Escalation mostyl for:
  • Acute complaints
  • Abnormal vitals / blood result requiring MO attention
  • High-risk pregnancy or complications
• Note case discussed / referred to MO in the template
• Allocate to MCH Room 25 when necessary

C

ED / Labor Room Referral

• Generate referral letter in CCMS
• Allocate patient to Procedure Room (Room 8)
• Prepare PIC for referral
• MCH ED Referral Protocol↴
• >32 weeks gestation → Labor Room, HPSFM
• <32 weeks gestation → ED, HPSFM

B

Further Investigation

• Allocate to procedure room or lab
• Diagnostic ordered via CCMS
• Update checklist

5

Appointment & Discharge

Discharged

• Set next appointment in SystmOne rota; TCA card given
• Medication prescribed in SystmOne — PHIS integration
• Update checklist & guide patient to Pharmacy Unit
• Documentation printouts attached to Pink Book
• Patient discharged home

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2. Appointment System & Services

Following consultation and treatment by attending nurses/doctors, if follow-up is necessary, the staff will set the next appointment date using the SystmOne rota and appointment system.

Category	Details
Appointment Documentation	Fully managed via SystmOne. MyVAS is not used for appointments.
Standard Appointment Periods	Nurses Antenatal Follow-Up: per case basis Doctor Antenatal Follow-Up Family Planning & Contraception Follow-Up Post-natal Care Child Health Routine Assessment: based on child age Blood-Taking Appointments Virtual Consultation Appointment: per case basis
Appointment Slot Limits	Nurses Antenatal Follow-Up: 30 patients/day Doctor Antenatal Follow-Up: 15 patients/day per doctor Doctor Procedure Follow-Up: 5 patients/day (Friday only)
Appointment Counter Staff Responsibilities	Ensure accurate documentation of appointment in SystmOne Advise the patient to attend punctually on the given date Inform the patient that any rescheduling must be done by phone

For general appointment mechanics (SystmOne rota, TCA card issuance, slot limits across all units, and defaulter tracing), see OPD Appointment & TCA Management↴.

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3. Escalation & High-Risk Case Handling

3.1 General Escalation Rules

Patients assessed in the MCH Unit must be escalated to Medical Officers or referred as follows:

• Escalation to MO: for acute complaints requiring medical attention, abnormal vitals, high-risk pregnancy, or complications.
• Referral to ED: for emergency conditions, e.g. seizures, bleeding, fainting during antenatal.
• Appointment Issued: for further structured follow-up in MCH.
• Notifiable Disease Detected (e.g. Syphilis, Hep B): notify Inspektor Kesihatan via designated channel & e-notis website.

All escalations must be documented in the template and reflected in the patient's SystmOne status.

For general ED referral mechanics (referral letter preparation, escort rules, high-risk coordination, and conditional pathways), see OPD Referral & Escalation↴.

3.2 MCH Referral to Emergency Department (ED) Protocol

Referral from MCH Unit to Hospital Emergency Services or Labor Room must follow these clinical pathways:

1. Pregnant women more than 32 weeks gestation → Refer directly to Labor Room, HPSF Muar.
2. Pregnant women less than 32 weeks gestation → Refer to Emergency Department, HPSF Muar.
3. Reduced fetal movement (RFM) → Refer directly to Labor Room, HPSF Muar.
4. All acute or high-risk cases → Must be discussed with the respective O&G Specialist at HPSF Muar prior to referral.

Why the 32-Week Threshold?

At more than 32 weeks gestation, the fetus is considered viable and the mother may be approaching labour. Direct referral to the Labor Room ensures immediate obstetric readiness for potential delivery. At less than 32 weeks, the presentation is more likely to require emergency stabilisation and assessment first, hence referral to the Emergency Department for triage and acute management before specialist handover.

This referral protocol must be documented in the SystmOne template along with referral details & name of the consulting specialist (when applicable).